Is Myeloproliferative Neoplasm with Splanchnic Vein Thrombosis a Distinct Clinical Entity?

Clinical History: A 29 year-old previously healthy female presented with sub-acute symptoms of weight loss, right upper quadrant pain and nausea. CBC results: WBC-11.7, Hb- 12.5, Platelet- 286, MCV- 90, MCV- 26.8, RDW- 18%. Imaging: Ultrasound and MRI of the abdomen were suggestive of Budd-Chiari syndrome that was supported by a liver biopsy showing features of hepatic outflow obstruction(Figure 1). There was no clinical or radiological evidence of splenomegaly. The hypercoagulable work-up was negative. An underlying Myeloproliferative Neoplasm (MPN) was suspected

Genomic Analysis of Advanced Breast Cancer Using Two Types of Next Generation Sequencing

The aim of this study is to characterize the genomic alterations of advance stage breast cancer using next generation sequencing (NGS) to identify pathways that may be commonly altered in advance stage breast cancer

Analysis of patient results distributions to reevaluate a reference range change for calcium, after a change in assay reagents on the Roche Cobas c500 analyzer

Introduction: A change in reagents for calcium (Ca) on the Roche Cobas c500 used in our laboratory analyzer took place in 2013. The previous reference range (8.5-10.5 mg/dL) was replaced with that from the manufacturer\u27s study (8.6-10.0 mg/dL), based on correlation of results between the new and old assays. As a matter of quality assurance, we undertook a post-assay-change reevaluation of the reference range change, using a method based on that of Bhattacharya [1]. In short, the method relies on the assumption that the reference range is a normal distribution, which assumption enables this distribution to be isolated mathematically from within all-comers patient distribution data that are not normally distributed

Is Hemoglobin Variant Analysis Helpful in the Diagnostic Work-up of Patients Revealing Microcytic Erythrocytosis on Complete Blood Count?

Introduction: Microcytic erythrocytosis is an abnormal CBC (complete blood count) finding that is under-recognized, poorly understood, and consequently under-utilized in patient care. It is characterized by decreased MCV and increased RBC count. Its etiology is likely multifactorial and includes thalassemias and hemoglobinopathies. The focus of our study was to determine the relative prevalence of hemoglobin-associated disorders in patients revealing microcytic erythrocytosis on CBC and to demonstrate whether or not hemoglobin variant analysis should be included in the diagnostic work-up of such cases

The Predictive Value of the Proliferation Marker Ki-67 in Patients with Fulminant Hepatic Failure

INTRODUCTION In the United States, acute liver failure (ALF) affects an estimated 2,000 people per year and accounts for 6% of all liver transplants. Without transplantation, however, less than 50% of patients survive with medical management alone. Early identification of patients with survivable AFL is important to guiding their management and early referral to transplantation. Studies have shown that the current prognostic scoring systems used for FHF, including the King’s College Criteria (KCC) and the Model for End- Stage Liver Disease (MELD), have poor sensitivity and negative predictive value for predicting outcome, highlighting a need for more accurate predictive models. Ki-67 is a well-established marker of cellular proliferation but its expression in FHF as a surrogate marker of liver regeneration has not been studied as a tool to predict outcome in these patients. In this pilot study, we sought to determine the predictive value of Ki-67 expression in patients with FHF and its potential for improving the accuracy of current predictive models

Le curriculum caché dans les disciplines médicales : examen de sa portée, de ses incidences et de son contexte

Background: While research suggests that manifestations of the hidden curriculum (HC) phenomenon have the potential to reinforce or undermine the values of an institution, very few studies have comprehensively measured its scope, impact, and the varied clinical teaching and learning contexts within which they occur. We explored the HC and examined the validity of newly developed constructs and determined the influence of context on the HC. Methods: We surveyed medical students (n =182), residents (n =148), and faculty (n = 140) from all disciplines at our institution between 2019 and 2020. Based on prior research and expertise, we measured participants’ experience with the HC including perceptions of respect and disrespect for different medical disciplines, settings in which the HC is experienced, impact of the HC, personal actions, efficacy, and their institutional perceptions. We examined the factor structure, reliability, and validity of the HC constructs using exploratory factor analysis Cronbach’s alpha, regression analysis and Pearson’s correlations. Results: Expert judges (physician faculty and medical learners) confirmed the content validity of the items used and the analysis revealed new HC constructs reflecting negative expressions, positive impacts and expressions, negative impacts, personal actions, and positive institutional perceptions of the HC. Evidence for criterion validity was found for the negative impacts and the personal actions constructs and were significantly associated with the stage of respondents’ career and gender. Support for convergent validity was obtained for HC constructs that were significantly correlated with certain contexts within which the HC occurs. Conclusion: More unique dimensions and contexts of the HC exist than have been previously documented. The findings demonstrate that specific clinical contexts can be targeted to improve negative expressions and impacts of the HC.Contexte : Bien que la recherche suggère que les expressions du curriculum caché (CC) ont le potentiel de renforcer ou de miner les valeurs d’un établissement, très peu d’études ont mesuré de manière exhaustive sa portée, ses effets et les divers contextes d’enseignement et d’apprentissage cliniques dans lesquels elles se produisent. Nous avons exploré le CC, examiné la validité de nouvelles notions et déterminé l’influence du contexte sur le CC. Méthodes : Entre 2019 et 2020, nous avons interrogé des étudiants (n =182), des résidents (n =148) et des membres du corps professoral (n = 140) de notre établissement, toutes disciplines médicales confondues. Sur la base de recherches et d’expertises antérieures, nous avons mesuré l’expérience des participants par rapport au CC, y compris leurs perceptions du respect ou du non-respect des diverses disciplines médicales, les contextes dans lesquels ils ont été confrontés au CC, les effets et l’efficacité du CC, les perceptions de l’établissement et les actions personnelles des participants. Nous avons examiné la structure factorielle, la fiabilité et la validité des notions du CC à l’aide d’une analyse factorielle exploratoire, du coefficient alpha de Cronbach, d’une analyse de régression et des corrélations de Pearson. Résultats : Des juges experts (médecins enseignants et apprenants) ont confirmé la validité du contenu des éléments utilisés et l’analyse a révélé de nouvelles notions du CC reflétant des expressions et des effets négatifs, des expressions et des effets positifs, des actions personnelles et des perceptions positives du CC au sein des établissements. La validité de critère a été démontrée pour les notions d’impacts négatifs et d’actions personnelles et a été associée de manière significative à l’étape de la carrière des répondants et à leur sexe. La validité convergente a été confirmée pour les notions de CC qui étaient significativement corrélées à certains contextes dans lesquels le CC se manifeste. Conclusion : Il existe plus de dimensions et de contextes uniques du CC que ceux qui avaient été documentés par le passé. Nos résultats montrent que des contextes cliniques spécifiques peuvent être ciblés pour améliorer les expressions et les effets négatifs du CC